Abstract: The Health Information Act of 2010 has presented an opportunity to discuss, establish, and promote innovative ways to incorporate tobacco cessation assistance to patients in the health care setting. This article provides an overview of the development and implementation of an electronic tobacco cessation protocol (the eTobacco protocol), into an electronic medical record (EMR) system, while evaluating the barriers and benefits encountered. The protocol was developed to facilitate the process of electronically referring patients to a state-funded quitline service by establishing a one-click connect for providers to use within the EMR system. While evaluating the implementation of the protocol, findings indicate that several barriers were encountered including disruption of clinic workflow, EMR limitations, and training complications. In spite of the barriers, the protocol shows promising results by increasing referrals to the quitline from 7 patients the year prior to implementation to 1,254 patients after the implementation of the electronic solution. Health care systems that have the ability to modify their EMR system can help lower tobacco use rates among their patients while meeting Meaningful Use requirements. Future research should examine if referrals through the eTobacco protocol are directly associated with patients’ tobacco cessation rates.

Using Cognitive Interviewing to Better Assess Young Adult E-cigarette Use

Introduction: Characteristics of electronic nicotine delivery systems (ENDS) make assessment of their use a challenge for researchers. Cognitive interviews are a way of gaining insight into participants’ interpretations of survey questions and the methods they use in answering them, to improve survey tools.

Methods: We used cognitive interviews to modify a young adult survey and improve assessment of quantity and frequency of ENDS use, as well as reasons for initiation and use of ENDS products. Twenty-five college students between the ages of 18 and 32 participated in individual cognitive interviews, which assessed question comprehension, answer estimation, retrieval processes, and answer response processes.

Results: Comprehension issues arose discerning between ENDS device types (e.g., cigalikes versus vape pens), and answer estimation issues arose regarding ENDS use as drug delivery systems. These issues appeared to improve when pictures were added specifying the device in question, as well as when specific language naming nicotine as the ENDS product content was added to survey questions. Regarding answer retrieval, this sample of users had problems reporting their frequency of ENDS use as well as quantifying the amount of ENDS products consumed (e.g., volume of e-juice, number of cartridges, nicotine concentration).

Conclusions: Accurate assessment of ENDS products proved challenging, but cognitive interviews provided valuable insight into survey interpretation that was otherwise inaccessible to researchers. Future research that explores how to assess the wide array of ENDS devices, as well as possible population differences among specific device-type users would be valuable to public health researchers and professionals.

Dr. Loukas' research focuses on adolescent health, particularly adolescent aggression and tobacco use and cessation in disparate populations. She is a Professor and Program Director of Health Behavior and Health Education in the Department of Kinesiology & Health Education at the University of Texas at Austin.